High Specificity of the Word Memory Test and Medical Symptom Validity Test in Groups with Severe Verbal Memory Impairment

Abstract

By definition, false positives occur when an otherwise very easy symptom validity test (SVT) or effort test is failed because of cognitive impairment and not because of poor effort. Therefore, the highest rate of false positives will be found in those groups with the most severe cognitive impairment. For that reason, it is important to study people with severe impairment when evaluating the specificity of SVTs. Some people with various types of dementia, notably those with Alzheimer's disease, suffer from severe impairment of memory and other cognitive abilities. In this study, patients with possible or probable dementia were tested with the Word Memory Test (WMT; Green, 2003; Green & Astner, 1995) and the Medical Symptom Validity Test (MSVT; Green, 2004). While some dementia patients failed the easy subtests of these instruments and had severe verbal memory impairment, they showed distinctive profiles of scores that have been reported to be characteristic of people with severe impairment. Using profile analysis, the WMT and MSVT achieved a specificity of 98.4% or higher in the patients of the current study. This suggests that there will be extremely low false positive rates using the same methods in people with relatively minor impairment of the type found in, for example, mild traumatic brain injury or depression.

Body mass and cognitive decline are indirectly associated via inflammation among aging adults

“…Although we benchmarked the size of our effect to another established predictor of cognitive decline, chronological age, caution is still warranted in cases in which associations are small. Third, though our cognitive measures have been previously validated (Green et al, 2011;Haugrud et al, 2011;Hoskins et al, 2010), they are only single indicators of the broad constructs of EF and memory. It would be useful in future studies to assess multiple domains of EF and memory, among other cognitive domains.…”

“…Ten words were presented and participants attempted to recall the words immediately, then again five minutes later, and the two scores were averaged. Similar assessments have been used extensively to measure immediate and delayed memory performance (Green, Montijo, & Brockhaus, 2011;Hoskins, Binder, Chaytor, Williamson, & Drane, 2010).…”

Social participation predicts cognitive functioning in aging adults over time: comparisons with physical health, depression, and physical activity

“…The two scores were averaged to create the measure of memory. This assessment was constructed based on similar computerized word recall tasks that have been used extensively to assess immediate and delayed memory performance (Green, Montijo, & Brockhaus, 2011;Hoskins, Binder, Chaytor, Williamson, & Drane, 2010).…”

Performance on Standard Indexes of Effort Among Patients with Dementia

“…Additionally, as data were collected as part of routine clinical practice, there was no definitive, external criterion for determining good versus suspect effort, and thus, a combination of criteria similar to those previously reported (Barker et al, 2010;Slick et al, 1999) had to be used. In future studies, the use of effort measures such as the WMT, MSVT, or NV-MSVT rather than the TOMM could improve classification of effort in dementia samples, given that these tests have been shown to yield extremely high specificity levels in groups of patients with dementia (e.g., Green, Montijo, & Brockhaus, 2011;Singhal, Green, Ashaye, Shankar, & Gill, 2009). It is also recommended that where possible, performance on concurrent measures of effort be used given the additional research needed on effort measures that provide dementia profiles to establish the sensitivity of any one of the measures used alone versus the use of two or three of the measures in combination.…”

“…in differentiating between true dementia versus suspect effort. Moreover, for patients with true dementia (i.e., not those with mild memory complaints), use of effort measures that provide dementia profiles (such as the WMT, MSVT, or NV-MSVT) should be utilized because of their robustness (i.e., very low false-positive rates of error) in dementia samples (e.g., Green et al, 2011;Henry et al, 2010;Howe et al, 2007;Howe & Loring, 2009). …”